Low-dose pulsed vs standard pulsed fluoroscopy during ERCP to reduce radiation without change in image quality: Prospective randomized study

Author:

Ali Osman1,Kesar Varun2,Alizadeh Madeline3ORCID,Kalachi Kourosh1,Twery Benjamin1,Wellnitz Nicholas4,Kim Raymond Eunho5,Goldberg Eric1,Uradomo Lance T6,Darwin Peter E1

Affiliation:

1. Gastroenterology, University of Maryland School of Medicine, Baltimore, United States

2. Gastroenterology and Hepatology, Carilion Clinic, Roanoke, United States

3. IGS, University of Maryland Institute for Genome Sciences, Silver Spring, United States

4. A&F Environmental Health & Safety, University of Maryland Baltimore, Baltimore, United States

5. Gastroenterology and Hepatology, University of Maryland Baltimore, Baltimore, United States

6. Gastroeneterology, City of Hope Comprehensive Cancer Center, Duarte, United States

Abstract

Abstract Background and study aims Endoscopic retrograde cholangiopancreatography (ERCP) poses the risk of radiation exposure (RE) to patients and staff and increases the risk of adverse biological effects such as cataracts, sterility, and cancer. Newer fluoroscopy equipment (C-Arm) provides options to limit radiation in the form of lower radiation dose and frame rate or time-limited “pulsed” settings. However, the impact of lower settings on image quality has not been assessed, and no standard protocol exists for fluoroscopy settings used during ERCP. Patients and methods This was a single-center, double-blind, prospective randomized study of consecutive adult patients undergoing standard-of-care ERCP at a tertiary academic medical center. Patients were randomized into two groups: 1) standard-dose pulsed and 2) low-dose pulsed. Pulsed mode (8 fps) was defined as x-ray exposure either in the manufacturer standard-dose or low-dose settings limited to 3 seconds each time the foot-operated switch was depressed. Results Seventy-eight patients undergoing ERCP were enrolled and randomized. No difference in age, gender, or body mass index was found between the two groups. No significant difference in image quality was found between standard-dose and low-dose fluoroscopy P = 0.925). The low-dose group was exposed to significantly less radiation when compared with standard-dose P < 0.05). Fluoroscopy time (minutes) was similar in both groups (2.0 vs 1.9), further suggesting that group assignment had no impact on image quality or procedure time. Conclusions Low-dose pulsed fluoroscopy is a reliable method that substantially reduces radiation without compromising image quality or affecting procedure or fluoroscopy times. This underscores the need for standardization in ERCP fluoroscopy settings to limit radiation exposure.

Funder

National Institute of Diabetes and Digestive and Kidney Diseases

Publisher

Georg Thieme Verlag KG

Reference32 articles.

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